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Background: The limitations of the soft-tissue envelope, devascularized bone grafts, and relapse of the deformity are important considerations in the surgical treatment of unicoronal craniosynostosis. The authors report their technique evolution of distraction osteogenesis for treatment of patients with unicoronal craniosynostosis.

Results: Sixteen patients with nonsyndromic unicoronal craniosynostosis underwent repair between August of 2013 and December of 2016. Mean age was 9.0 months. Distractors were advanced a mean of 27.1 mm and achieved a cranial volume change of 29.5 percent, with a mean efficiency of 1.3 percent increase per millimeter of distraction. Mean operating time was 169.3 minutes. Complications were predominately related to infections at the distractor site. At most recent follow-up, all patients had a Whitaker grade I result.

Conclusions: Distraction osteogenesis can be a safe and effective method of achieving satisfactory aesthetic outcomes and volume expansion for patients with unicoronal craniosynostosis. The technique presented is proposed to maximize bone flap viability and limit relapse of deformity. Further long-term follow-up is needed for definitive comparison with traditional anterior cranial vault reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

This and Related “Classic” Articles Appear on Prsjournal.com for Journal Club Discussions.

La Jolla and San Diego, Calif.

From the School of Medicine, the Division of Plastic Surgery, Department of Surgery, and the Department of Neurosurgery, University of California, San Diego; and the Fresh Start Center for Craniofacial Anomalies, Rady Children’s Hospital San Diego.

Received for publication November 21, 2017; accepted June 28, 2018.

Presented at the Joint American Society of Craniofacial Surgery and American Society of Pediatric Neurosurgeons Symposium, in Maui, Hawaii, January 24 through 25, 2017.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

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David H. Song, M.D., M.B.A. is the President-elect of the American Society of Plastic Surgeons (ASPS). He is a consultant with BioMet, Emmi Solutions, LLC, a consortium-member providing senior debt for Brava, and consultant with and investor in HealthEngine.com. He receives author royalties from Elsevier. Scot Glasberg, M.D. is the President of the American Society of Plastic Surgeons (ASPS). He is a consultant with LifeCell Corp and Mentor Corp and an investor with Strathspey Crown. The authors have no sources of funding to report related to the writing or submission of this discussion.

The location and affiliation information should read as follows: Arlington Heights, Ill. From the American Society of Plastic Surgeons/Plastic Surgery Foundation.